Article by Franchis Adam
Gout is a painful and potentially disabling rheumatic disease and is one of the most common forms of arthritis. Gout accounts for approximately 5% of all cases of arthritis. It usually affects the first metatarsal phalangeal joint of the big toe (hallux) or the ankle joints. Gout most often affects the big toe but can also affect the ankle, knee, foot, hand, wrist and elbow. Approximately one million people in the United States suffer from attacks of gout. Gout is nine times more common in men than in women. It predominantly attacks males after puberty, with a peak age of 75. In women, gout attacks usually occur after menopause.
The most common gout symptom is sudden, severe attacks of pain, tenderness, redness, warmth and swelling in some joints. It usually affects one joint at a time, especially the joint of the big toe, but can also affect the knee, ankle, foot, hand, wrist and elbow. Deposits of uric acid, called tophi, can appear as lumps under the skin around the joints and at the rim of the ear. In addition, uric acid crystals can also collect in the kidneys and cause kidney stones.
A definitive diagnosis of gout is from light microscopy of fluid aspirated from the joints (this test may be difficult to perform) to demonstrate intracellular monosodium urate crystals in synovial fluid polymorphonuclear leukocytes. The urate crystal is identified by strong negative birefringence under polarised microscopy and its needle-like morphology. A trained observer does better in distinguishing them from other crystals.
Alcohol and certain foods can trigger a gout attack. Events such as strokes, heart attacks or surgery may also cause gout.
Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes. Because of genetic factors, gout tends to run in some families. A variety of treatments can help you manage your gout. Traditionally treatment for acute gout has consisted of colchicine, which can be effective if given early in the attack.
Gout often is treated with nonsteroidal anti-inflammatories (NSAIDs) such as naproxen (e.g., Anaprox, Naprosyn) and indomethacin (e.g., Indocin), usually for 3